NCCN Guidelines for Patients® | Chronic Myeloid Leukemia

38 NCCN Guidelines for Patients ® : Chronic Myeloid Leukemia, 2018 5 Advanced phases HCT follow-up treatment Chemotherapy Chemotherapy may be added to TKI treatment. The type of chemotherapy you will have depends on the main cell type. If lymphoid type, you will have chemotherapy that is used for ALL. If myeloid type, you will have chemotherapy that is used for AML. Steroid Steroid is the short name for corticosteroid. It is a type of drug that is often used to relieve inflammation. Steroids also are toxic to lymphoid cells. Thus, a steroid may be added to TKI treatment for lymphoid type. CNS treatment Sometimes CML involves or relapses in the CNS ( c entral n ervous s ystem). In this case, special treatment is needed. CNS treatment may include chemotherapy injected into spinal fluid. This chemotherapy includes methotrexate, cytarabine, and steroids. CNS treatment may also be chemotherapy injected into a vein. This chemotherapy includes high-dose methotrexate, intermediate or high-dose cytarabine, mercaptopurine, and pegaspargase. Allogeneic HCT Allogeneic HCT is used after remission of blast- phase CML. It is the preferred treatment option. It may also be an option if T315I and other mutations cause TKIs not to work. Treatment results After a transplant, testing to assess the results is needed. Tests will include a medical history, physical exam, CBC with differential, and QPRC-IS. In due time, an HCT is needed. If the leukemia worsens, you may receive another treatment listed in Guide 7. HCT follow-up treatment Your doctor will assess if the allogeneic HCT worked. Signs that it did work include QPCR-IS results of BCR-ABL1 0.1% to BCR-ABL1 1%. An absence of the Philadelphia chromosome as measured by cytogenetics is another sign. Guide 8 lists options for the next steps of care. If HCT worked, results will be monitored with QPCR- IS. Testing will occur every 3 months for 2 years. If results stay normal, testing will then occur every 3 to 6 months thereafter. Taking a TKI for 1 year after HCT may improve results and prevent relapse. If HCT didn’t work or you have a relapse, talk with your transplant doctor about options. Options will depend on your prior treatment, mutations, and health. One option may be a TKI. Getting a DLI ( d onor l ymphocyte i nfusion) with TKI may cause a fast drop in BCR-ABL1 . DLI consists of receiving lymphocytes from the same person who donated the blood stem cells for the HCT. A third option may be omacetaxine. It is given when two or more TKIs didn’t work. The fourth option is to receive treatment within a clinical trial. Guide 8. Treatment after HCT Test results What are the options? Transplant worked • Think about taking TKI for 1 year Transplant did not work or the leukemia has worsened after successful transplant • TKI • TKI + DLI • Omacetaxine • Clinical trial